Promoting Rational Drug Use in the Community What influences drug use by consumers.

Promoting Rational Drug Use in the Community

What influences drug use by consumers

What influences drug use by consumersPromoting Rational Drug Use in the Community

2WHO

Objectives

To be able to:

Identify various factors which influence drug use by consumers

Recognise relative importance of the factors with respect to efforts to promote rational drug use by consumers


3WHO

The session

Various factors which influence drug use by consumers

by level of influence

related both to environment and behaviour

provides a basis to analyse problems

to be used in the development of interventions


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Layers of influence

the family level

the community

the health service institution

the national level

the international level


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The family level

perceived need for drugs

ideas about efficacy and safety

uncertainty - poly-pharmacy

division of drug consumption roles

cost of medicines

literacy level

the power of medicines


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Perceived safety and efficacy

related to colour, taste and shape of medicines

related to dosage form

depends on compatibility between medicine and the person

depends on cause of illness

related to past experiences

new medicines perceived to be better


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Gender roles and medicines

Philippines mothers buy mothers give

to children neighbours or

relatives give advice

husband not consulted generally

Pakistanfathers buymothers give tochildrenmen haveinformation aboutmedicines andtell wives how to use them


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The community level

local drug-use culture

drug supply system

community information channels


9WHO

Town

Clinics (2%)

Hospital (1%)

Doctors (7%)

Drugstores (35%)

Household stocks andfree-clinics (8%)

Neighbourhoodstores (40%)

Neighbours andrelatives (5%)

Neighbourhood

MEDICINES (n=1324)

Community drug distribution

Source: Hardon A (1991). Confronting ill health: medicines, self-care and the poor in Manila


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The health institution level

utilisation of health service

quality of health worker prescribing

quality of communication during consultation

quality of medicine dispensing

regular supply of medicines

cost of medicines


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Extent to which health worker advice is sought

Thailand: 7% of 1755 episodes (rural)

Philippines: 8% of 1411 episodes (urban) 20% of 422 episodes (rural infants)

Pakistan: 56% in NGO-PHC area, 48% in controls (rural)

Ghana: 42% in urban, 43% in rural


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The national level

Implementation of essential drugs policy Drug promotion Drug costs, financing and reimbursement

policies Advocacy by consumer and patient

organizations Health communication on medicines in

school curricula, and in TV and radio programmes


13WHO

Drug promotion

Industry expenditure on marketing: research = 2 : 1

In fact 35% of sales revenues for drug marketing

Commercial drug info : public funded drug info = 50 : 1 (UK)

Drug promotion emphasises benefit, often lacking information on risks


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WHO ethical criteria on drug promotion (adopted in 1988)

consistent with national health policy

contains reliable claims

contains no omission which can lead to

health risks

should not be designed to disguise its

real nature


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Ethical criteria adoption:

WHO (1988): ethical criteria only

adopted in 17 out of 42 national drug

policies

Australia (1995): only 29% of 140

advertisements to the public contain

warnings or cautions about health risks


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OTC advertising: IOCU study

238 OTC ads in 11 countries reviewed (1994)

most ads do not comply with WHO ethical criteria

75% do not mention side-effects nor contraindications


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Increase in promotion towards consumers

prescription drugs are increasingly registered as OTC drugs

before patient was ignorant and prescriber the target, now consumer is target as “expert” in need of info.

direct to consumer advertising of prescription drugs increases

increase in promotion of life style drugs


18WHO

Top DTCA expenditures

137 million US$ on Claritin 93 million US$ Viagra*: to treat

impotence/improve sexual performance 75 million US$ on Xenical*: to reduce

weight 57 million US$ on Zyrtec 45 million US$ on Zyban*: to quit

smoking

*life-style drugs


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The international level

Implementation of multilateral agreements affecting drugs

Health consequences of global trade agreements

Donor support for essential drugs programmes

Global consumer advocacy The Internet


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Zyban: Information from the Internet

Nicotine-free ZYBAN is a prescription-strength medicine

ZYBAN is the first nicotine-free pill approved to help you quit smoking

You start taking ZYBAN and continue to smoke

ZYBAN is priced lower than other smoking cessation therapy


21WHO

Activity tasks

Participants should have read the case studies prior to session

Appoint a rapporteur and facilitator Facilitator should check if case study

has been read. If not, allow for time The facilitator guides the discussion Answer discussion questions Rapporteur reports in plenary


22WHO

DTCA discussion questions

Make an inventory of the ways in which prescription drugs are promoted to consumers in the Philippines

Discuss use of Viagra by young men as aphrodisiac. What factors influence it?

Define possible solutions to this misuse Discuss pros and cons of DTCA in the

Philippines


23WHO

Discussion questions: drugs used as abortifacients

What medicines are used as

abortifacients in the Philippines

What are health risks?

What factors determine this misuse?

What can be done to discourage this

misuse?

Promoting Rational Drug Use in the Community What influences drug use by consumers.

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